Patient to surgeon infections—fact or fiction

Needlestick injuries during surgical procedures: a multidisciplinary online study

BACKGROUND

Needlestick injuries are common during surgical procedures. Following such an injury, local protocols should be followed to minimize the risk of infection.

AIMS

To identify who sustains such injuries, under what circumstances and what actions are taken to minimize the risk and in response to intraoperative needlestick injuries.

METHODS

A questionnaire was submitted via e-mail to all staff in a National Health Service trust who took part in operations. The results were checked against occupational health department (OHD) records.

RESULTS

One hundred and thirty-six of 255 appropriate responders completed the questionnaire (53%). Fifteen of 31 consultants (48%), 12/36 junior doctors (33%), 0/39 midwives (0%) and 8/30 theatre staff (27%) reported having had at least one intraoperative needlestick injury over the past year. Awareness of local protocols was significantly worse in the junior doctor group. Ninety-three percent of consultants, 67% of junior doctors and 13% of theatre staff did not comply with local protocols. The length of time it takes to do so (48%) and a perceived low infection risk of the patient (78%) were the commonest reasons for this. Hand dominance, role during surgery and double gloving were not significant risk factors; however, rare use of a no-touch technique was. Comparison with OHD records suggested that a maximum of 16% of intraoperative needlestick injuries were dealt with in accordance to local policy.

CONCLUSIONS

Non-compliance with needlestick injury protocols is commonest among senior surgical staff. A revision of the protocol to reduce the time it takes to complete it may improve compliance.

Hand injuries during hand surgery: a survey of intraoperative sharp injuries of the hand among hand surgeons

An e-mail survey comprising 19 questions was directed towards members of the American Society for Surgery of the Hand (ASSH) to investigate the prevalence and nature of intraoperative injuries to hand surgeons during hand surgery. The responses were collected, statistical analysis was done and trends were extrapolated. Two hundred members of the ASSH completed the e-mail survey. A hand surgeon in practice for greater than 10 years has a 97% chance of sustaining an intraoperative "sharps" injury. The injury is self-inflicted (88%) in most cases and the index finger (94%) of the left hand (87%) is the most likely site. The suture needle was the cause in 91% of cases. Awareness of the risks and factors associated with hand injuries during hand surgery and adopting intraoperative measures are important strategies for preventing these potentially serious and life-threatening accidents.

Use of Ligasure in Thyroidectomy Procedures: Results of a Prospective Comparative Study

The thyroidectomy procedure requires many manupulations to achieve prompt hemostasis. This study assessed whether the outcomes of thyroidectomy using the Ligasure electrothermal vessel sealer were comparable with the conventional suture-ligation technique. We prospectively evaluated 58 consecutive patients who underwent thyroidectomy. Patients were allocated into two groups according to their preference. There were 30 patients in the Ligasure group and 28 patients in the conventional surgery group. Complications, operating time, and hospital stay were compared between the two groups and suture-ligations performed in the Ligasure group were recorded. The age, sex, and indications were similar in the two groups (p > 0.05). Complication rates and hospital stays did not show any difference according to the techniques used. Operating time was shorter in the hemithyroidectomy and total thyroidectomy patients of the Ligasure group (mean +/- SD: 77.38 +/- 13.71 vs. 99.80 +/- 12.53 minutes, p = 0.005; and 102.50 +/- 16.69 vs.128.89 +/- 19.74 minutes, p = 0.010). The mean +/- SD number of suture-ligations for each patient in the Ligasure group was 1.83 +/- 2.12. Thyroid surgery using the Ligasure is safe, and its complication rates are comparable to these found with the conventional surgical technique. Use of the Ligasure during hemithyroidectomy and total tyhroidectomy operations provides a significantly shorter operating time.